Attrition of women health care professionals is high, threatening patient care and advances in health care sciences. Women health care professionals have often reported experiencing challenges in the workplace that lower their sense of belonging and may precipitate their attrition. The current study sought to identify dimensions of workplace belonging in women health care professionals and to determine the relative strength of association of these belonging dimensions with intent to leave (ITL) their institution.
Methods:
Attendees of a continuing education course on women’s leadership skills in health care were surveyed about their ITL and workplace belonging experiences. Dimensions of workplace belonging were identified by factor analysis. The strength of association between ITL and each workplace belonging dimension, as well as their relative strengths of association, were assessed in ordinal regression analyses.
Results:
Women comprised 99% of survey participants. Three dimensions of workplace belonging were identified: “institutional culture,” “interactions with supervisor,” and “interpersonal relationships.” More frequent experiences of support in any of the three belonging dimensions associated strongly with lower ITL. When all three belonging dimensions were considered simultaneously, ITL remained strongly related with experiences of a supportive “institutional culture” (odds ratio 0.41, p < 0.0001), while it became much less strongly related with supportive experiences in the other two dimensions.
Conclusions:
These findings suggest a dominant role of institutional culture in attrition risk in women health care professionals. Interventions that foster an institutional culture of diversity, opportunities for career advancement, and inclusivity might be effective in improving retention of women health care professionals.
Get full access to this article
View all access options for this article.
References
1.
BondAM, CasalinoLP, Tai-SealeM, et al.Physician turnover in the United States. Ann Intern Med, 2023; 176(7):896–903; doi: 10.7326/M22-2504
2.
ChenYW, OrlasC, KimT, et al.Workforce attrition among male and female physicians working in US academic hospitals, 2014–2019. JAMA Netw Open, 2023; 6(7):e2323872; doi: 10.1001/jamanetworkopen.2023.23872
GilmartinMJ. Thirty years of nursing turnover research: Looking back to move forward. Med Care Res Rev, 2013; 70(1):3–28; doi: 10.1177/1077558712449056
6.
MakS, HuntM, RiccioSS, et al.Attrition and retention of rehabilitation professionals: A scoping review. J Contin Educ Health Prof, 2023; doi: 10.1097/CEH.0000000000000492
7.
HamidiMS, BohmanB, SandborgC, et al.Estimating institutional physician turnover attributable to self-reported burnout and associated financial burden: A Case Study. BMC Health Serv Res, 2018; 18(1):851; doi: 10.1186/s12913-018-3663-z
8.
SabetyAH, JenaAB, BarnettML. Changes in health care use and outcomes after turnover in primary care. JAMA Intern Med, 2021; 181(2):186–194; doi: 10.1001/jamainternmed.2020.6288
9.
ShenK, McGarryBE, GandhiAD. Health care staff turnover and quality of care at nursing homes. JAMA Intern Med, 2023; 183(11):1247–1254; doi: 10.1001/jamainternmed.2023.5225
10.
MilewiczDM, LorenzRG, DermodyTS, et al.National Association of MD-PhD Programs Executive Committee. Rescuing the physician-scientist workforce: The time for action is now. J Clin Invest, 2015; 125(10):3742–3747; doi: 10.1172/JCI84170
11.
FrognerBK, DillJS. Tracking turnover among health care workers during the COVID-19 pandemic: A cross-sectional study. JAMA Health Forum, 2022; 3(4):e220371; doi: 10.1001/jamahealthforum.2022.0371
12.
SilverJK, BeanAC, SlocumC, et al.Physician workforce disparities and patient care: A narrative review. Health Equity, 2019; 3(1):360–377; doi: 10.1089/heq.2019.0040
13.
MisraJ, Smith-DoerrL, DasguptaN, et al.Collaboration and gender equity among academic scientists. Social Sciences, 2017; 6(1):25; doi: 10.3390/socsci6010025
14.
Smith-DoerrL, AlegriaS, SaccoT. How diversity matters in the US science and engineering workforce: A critical review considering integration in teams, fields, and organizational contexts. Engaging STS, 2017; 3:139–153; doi: 10.17351/ests2017.142
15.
Center for Talent Innovation. The Power of Belonging: What It Is and Why It Matters in Today’s Workplace. 2020. Available from: https://coqual.org/reports/the-power-of-belonging [Last accessed: August1, 2022].
16.
WallerL. Fostering a sense of belonging in the workplace: enhancing well-being and a positive and coherent sense of self. In: The Palgrave Handbook of Workplace Well-Being. (DhimanSK. eds.) Springer International Publishing: Cham, 2021, pp. 341–367.
SallesA, WrightRC, MilamL, et al.Social belonging as a predictor of surgical resident well-being and attrition. J Surg Educ, 2019; 76(2):370–377; doi: 10.1016/j.jsurg.2018.08.022
CanlasAL, WilliamsMR. Meeting belongingness needs: An inclusive leadership practitioner’s approach. Adv Dev Hum Resour, 2022; 24(4):225–241; doi: 10.1177/15234223221118953
23.
PololiLH, JonesSJ. Women faculty: An analysis of their experiences in academic medicine and their coping strategies. Gend Med, 2010; 7(5):438–450; doi: 10.1016/j.genm.2010.09.006
24.
CochranA, NeumayerLA, ElderWB. Barriers to careers identified by women in academic surgery: A grounded theory model. Am J Surg, 2019; 218(4):780–785; doi: 10.1016/j.amjsurg.2019.07.015
25.
LinMP, LallMD, Samuels-KalowM, et al.Impact of a women-focused professional organization on academic retention and advancement: Perceptions from a Qualitative Study. Acad Emerg Med, 2019; 26(3):303–316; doi: 10.1111/acem.13699
26.
Lane-FallMB, GordonEKB, ValentineEA, et al.Fostering belonging in academic anaesthesiology: Faculty and department chair perspectives on supporting women anaesthesiologists. Br J Anaesth, 2020; 124(3):e155–e159; doi: 10.1016/j.bja.2019.12.023
27.
HagginsAN. To be seen, heard, and valued: Strategies to promote a sense of belonging for women and underrepresented in medicine physicians. Acad Med, 2020; 95(10):1507–1510; doi: 10.1097/ACM.0000000000003553
28.
SalemV, HiraniD, LloydC, et al.Why are women still leaving academic medicine? A qualitative study within a London Medical School. BMJ Open, 2022; 12(6):e057847; doi: 10.1136/bmjopen-2021-057847
29.
YoderJB, MattheisA. Queer in STEM: Workplace experiences reported in a national survey of LGBTQA individuals in science, technology, engineering, and mathematics careers. J Homosex, 2016; 63(1):1–27; doi: 10.1080/00918369.2015.1078632
30.
CechEA, WaidzunasTJ. Systemic inequalities for LGBTQ professionals in STEM. Sci Adv, 2021; 7(3):eabe0933; doi: 10.1126/sciadv.abe0933
31.
SchaechterJD, GoldsteinR, ZafonteRD, et al.Workplace belonging of women healthcare professionals relates to likelihood of leaving. J Healthc Leadersh, 2023; 15:273–284; doi: 10.2147/JHL.S431157
32.
CarapinhaR, McCrackenCM, WarnerET, et al.Organizational context and female faculty’s perception of the climate for women in academic medicine. J Womens Health (Larchmt), 2017; 26(5):549–559; doi: 10.1089/jwh.2016.6020
33.
LinzerM, ManwellLB, WilliamsES, et al.MEMO (Minimizing Error, Maximizing Outcome) Investigators. Working conditions in primary care: Physician reactions and care quality. Ann Intern Med, 2009; 151(1):28–36; doi: 10.7326/0003-4819-151-1-200907070-00006
34.
PersonSD, JordanCG, AllisonJJ, et al.Measuring diversity and inclusion in academic medicine: The diversity engagement survey. Acad Med, 2015; 90(12):1675–1683; doi: 10.1097/ACM.0000000000000921
35.
PololiLH, KrupatE, CivianJT, et al.Why are a quarter of faculty considering leaving academic medicine? A study of their perceptions of institutional culture and intentions to leave at 26 representative U.S. medical schools. Acad Med, 2012; 87(7):859–869; doi: 10.1097/ACM.0b013e3182582b18
36.
Thompson-BurdineJA, TelemDA, WaljeeJF, et al.Defining barriers and facilitators to advancement for women in academic surgery. JAMA Netw Open, 2019; 2(8):e1910228; doi: 10.1001/jamanetworkopen.2019.10228
37.
NewmanDA. Missing data: Five practical guidelines. Organ Res Methods, 2014; 17(4):372–411; doi: 10.1177/1094428114548590
38.
BauerGR, ScheimAI. Advancing quantitative intersectionality research methods: Intracategorical and intercategorical approaches to shared and differential constructs. Soc Sci Med, 2019; 226:260–262; doi: 10.1016/j.socscimed.2019.03.018
39.
BauerGR, ScheimAI. Methods for analytic intercategorical intersectionality in quantitative research: Discrimination as a mediator of health inequalities. Soc Sci Med, 2019; 226:236–245; doi: 10.1016/j.socscimed.2018.12.015
40.
KamakuraWA, WedelM. Factor analysis and missing data. J Mark Res, 2000; 37(4):490–498; doi: 10.1509/jmkr.37.4.490.18795
41.
CostelloAB, OsborneJ. Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Practical Assessment. Research and Evaluation, 2005; 10(Article 7):1–9; doi: 10.7275/jyj1-4868
42.
HowardMC. A review of exploratory factor analysis decisions and overview of current practices: What we are doing and how can we improve? Int J Hum–Comp Int, 2016; 32(1):51–62; doi: 10.1080/10447318.2015.1087664
43.
TavakolM, DennickR. Making sense of Cronbach’s alpha. Int J Med Educ, 2011; 2:53–55; doi: 10.5116/ijme.4dfb.8dfd
44.
EisenbergerR, StinglhamberF, VandenbergheC, et al.Perceived supervisor support: Contributions to perceived organizational support and employee retention. J Appl Psychol, 2002; 87(3):565–573; doi: 10.1037/0021-9010.87.3.565
45.
KivimäkiM, VanhalaA, PenttiJ, et al.Team climate, intention to leave and turnover among hospital employees: Prospective Cohort Study. BMC Health Serv Res, 2007; 7(1):170; doi: 10.1186/1472-6963-7-170
PololiLH, CivianJT, BrennanRT, et al.Experiencing the culture of academic medicine: Gender Matters, A National Study. J Gen Intern Med, 2013; 28(2):201–207; doi: 10.1007/s11606-012-2207-1
ChaudronLH, DandarV, LautenbergerD, et al.Satisfaction of women faculty in academic medicine. J Womens Health (Larchmt), 2024; 33(2):132–140; doi: 10.1089/jwh.2023.0152
50.
LigibelJA, GoularteN, BerlinerJI, et al.Well-being parameters and intention to leave current institution among academic physicians. JAMA Netw Open, 2023; 6(12):e2347894; doi: 10.1001/jamanetworkopen.2023.47894
51.
MasselinkLE, LeeSY, KonradTR. Workplace relational factors and physicians’ intention to withdraw from practice. Health Care Manage Rev, 2008; 33(2):178–187; doi: 10.1097/01.HMR.0000304507.50674.28
52.
JasińskiAM, DerbisR. Work stressors and intention to leave the current workplace and profession: The mediating role of negative affect at work. Int J Environ Res Public Health, 2022; 19(21); doi: 10.3390/ijerph192113992
53.
LabragueLJ, NwaforCE, TsarasK. Influence of toxic and transformational leadership practices on nurses’ job satisfaction, job stress, absenteeism and turnover intention: A cross-sectional study. J Nurs Manag, 2020; 28(5):1104–1113; doi: 10.1111/jonm.13053
54.
MartinussenPE, MagnussenJ, VrangbækK, et al.Should I stay or should I go? The role of leadership and organisational context for hospital physicians’ intention to leave their current job. BMC Health Serv Res, 2020; 20(1):400; doi: 10.1186/s12913-020-05285-4
55.
O’DonovanR, De BrúnA, McAuliffeE. Healthcare professionals experience of psychological safety, voice, and silence. Front Psychol, 2021; 12:626689; doi: 10.3389/fpsyg.2021.626689
56.
MeteM, GoldmanC, ShanafeltT, et al.Impact of leadership behaviour on physician well-being, burnout, professional fulfilment and intent to leave: A multicentre cross-sectional survey study. BMJ Open, 2022; 12(6):e057554; doi: 10.1136/bmjopen-2021-057554
57.
PanagiotiM, PanagopoulouE, BowerP, et al.Controlled interventions to reduce burnout in physicians: A systematic review and meta-analysis. JAMA Intern Med, 2017; 177(2):195–205; doi: 10.1001/jamainternmed.2016.7674
58.
WestCP, DyrbyeLN, ErwinPJ, et al.Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. Lancet, 2016; 388(10057):2272–2281; doi: 10.1016/S0140-6736(16)31279-X
59.
CarrPL, GunnC, RajA, et al.Recruitment, promotion, and retention of women in academic medicine: How institutions are addressing gender disparities. Womens Health Issues, 2017; 27(3):374–381; doi: 10.1016/j.whi.2016.11.003
60.
MangurianC, SpectorND, ShimRS. Centering women of color to promote excellence in academic medicine. N Engl J Med, 2024; 390(2):102–104; doi: 10.1056/NEJMp2309206
AnnabiH, LebovitzS. Improving the retention of women in the IT workforce: An investigation of gender diversity interventions in the USA. Information Systems Journal, 2018; 28(6):1049–1081; doi: 10.1111/isj.12182
64.
ChangEH, MilkmanKL, GrometDM, et al.The mixed effects of online diversity training. Proc Natl Acad Sci U S A, 2019; 116(16):7778–7783; doi: 10.1073/pnas.1816076116
65.
MetinyurtT, Haynes-BaratzMC, BondMA. A systematic review of interventions to address workplace bias: What we know, what we don’t, and lessons learned. New Ideas in Psychology, 2021; 63:100879; doi: 10.1016/j.newideapsych.2021.100879
MuenchU, SindelarJ, BuschSH, et al.Salary differences between male and female registered nurses in the United States. JAMA, 2015; 313(12):1265–1267; doi: 10.1001/jama.2015.1487
69.
FrintnerMP, SiskB, ByrneBJ, et al.Gender differences in earnings of early- and midcareer pediatricians. Pediatrics, 2019; 144(4); doi: 10.1542/peds.2018-3955
70.
ZhouA, LeonC, O’ConorC, et al.The physician gender pay gap in Maryland: Current state and future directions. Ann Med, 2023; 55(2):2258923; doi: 10.1080/07853890.2023.2258923
71.
HoopsHE, BraselKJ, DeweyE, et al.Analysis of gender-based differences in surgery faculty compensation, promotion, and retention: Establishing equity. Ann Surg, 2018; 268(3):479–487; doi: 10.1097/SLA.0000000000002920
72.
National Academies of Sciences Engineering, and Medicine. The Science of Effective Mentorship in STEMM. National Academies Press: Washington, DC, 2019; doi: 10.17226/25568
73.
ChangS, GuindaniM, MorahanP, et al.Increasing promotion of women faculty in academic medicine: Impact of national career development programs. J Womens Health (Larchmt), 2020; 29(6):837–846; doi: 10.1089/jwh.2019.8044
74.
MohamedZ, Al-HmaimatN. The effectiveness of nurse residency programs on new graduate nurses’ retention: Systematic review. Heliyon, 2024; 10(5):e26272; doi: 10.1016/j.heliyon.2024.e26272
75.
LarteyS, CummingsG, Profetto-McGrathJ. Interventions that promote retention of experienced registered nurses in health care settings: A systematic review. J Nurs Manag, 2014; 22(8):1027–1041; doi: 10.1111/jonm.12105
76.
De VriesN, LavreysenO, BooneA, et al.Retaining healthcare workers: A systematic review of strategies for sustaining power in the workplace. Healthcare (Basel), 2023; 11(13); doi: 10.3390/healthcare11131887
EdmondsonAC, HigginsM, SingerS, et al.Understanding psychological safety in health care and education organizations: A comparative perspective. Research in Human Development, 2016; 13(1):65–83; doi: 10.1080/15427609.2016.1141280
79.
DesaiV, ConteAH, NguyenVT, et al.Veiled harm: Impacts of microaggressions on psychological safety and physician burnout. Perm J, 2023; 27(2):169–178; doi: 10.7812/TPP/23.017
DesaiT, AliS, FangX, et al.Equal work for unequal pay: The gender reimbursement gap for healthcare providers in the United States. Postgrad Med J, 2016; 92(1092):571–575; doi: 10.1136/postgradmedj-2016-134094
83.
ValleL, WengJ, JagsiR, et al.Assessment of differences in clinical activity and Medicare payments among female and male radiation oncologists. JAMA Netw Open, 2019; 2(3):e190932; doi: 10.1001/jamanetworkopen.2019.0932
84.
OshinowoTO, RalloMS, SchirmerCM, et al.Gender differences in Medicare practice and payments to neurosurgeons. JAMA Surg, 2024; 159(1):35–42; doi: 10.1001/jamasurg.2023.4988
85.
DillJS, FrognerBK. The gender wage gap among health care workers across educational and occupational groups. Health Aff Sch, 2024; 2(1):qxad090; doi: 10.1093/haschl/qxad090
86.
ButkusR, SerchenJ, MoyerDV, et al.Health and Public Policy Committee of the American College of Physicians. Achieving gender equity in physician compensation and career advancement: A position paper of the American College of Physicians. Ann Intern Med, 2018; 168(10):721–723; doi: 10.7326/m17-3438
87.
RabatinJ, WilliamsE, Baier ManwellL, et al.Predictors and outcomes of burnout in primary care physicians. J Prim Care Community Health, 2016; 7(1):41–43; doi: 10.1177/2150131915607799
88.
GoldJA, RoubinovD, JiaLS, et al.Gender differences in endowed chairs in medicine at top schools. JAMA Intern Med, 2020; 180(10):1391–1394; doi: 10.1001/jamainternmed.2020.2677
89.
RotensteinL, HarryE, WicknerP, et al.Contributors to gender differences in burnout and professional fulfillment: A survey of physician faculty. Jt Comm J Qual Patient Saf, 2021; 47(11):723–730; doi: 10.1016/j.jcjq.2021.08.002
90.
CarrPL, RajA, KaplanSE, et al.Gender differences in academic medicine: Retention, rank, and leadership comparisons from the National Faculty Survey. Acad Med, 2018; 93(11):1694–1699; doi: 10.1097/ACM.0000000000002146
91.
RichterKP, ClarkL, WickJA, et al.Women physicians and promotion in academic medicine. N Engl J Med, 2020; 383(22):2148–2157; doi: 10.1056/NEJMsa1916935
92.
OnumahC, WikstromS, ValenciaV, et al.What women need: A study of institutional factors and women faculty’s intent to remain in academic medicine. J Gen Intern Med, 2021; 36(7):2039–2047; doi: 10.1007/s11606-021-06771-z
93.
MatuleviciusSA, KhoKA, ReischJ, et al.Academic medicine faculty perceptions of work-life balance before and since the COVID-19 pandemic. JAMA Netw Open, 2021; 4(6):e2113539; doi: 10.1001/jamanetworkopen.2021.13539
94.
AppleR, O’BrienEC, DaraisehNM, et al.Gender and intention to leave healthcare during the COVID-19 pandemic among U.S. healthcare workers: A cross sectional analysis of the HERO registry. PLoS One, 2023; 18(6):e0287428; doi: 10.1371/journal.pone.0287428
95.
RittenhouseDR, MertzE, KeaneD, et al.No exit: An evaluation of measures of physician attrition. Health Serv Res, 2004; 39(5):1571–1588; doi: 10.1111/j.1475-6773.2004.00304.x
96.
HannM, ReevesD, SibbaldB. Relationships between job satisfaction, intentions to leave family practice and actually leaving among family physicians in England. Eur J Public Health, 2011; 21(4):499–503; doi: 10.1093/eurpub/ckq005
97.
DegenC, LiJ, AngererP. Physicians’ intention to leave direct patient care: An integrative review. Hum Resour Health, 2015; 13:74; doi: 10.1186/s12960-015-0068-5
98.
SpoonK, LaBergeN, WapmanKH, et al.Gender and retention patterns among U.S. faculty. Sci Adv, 2023; 9(42):eadi2205; doi: 10.1126/sciadv.adi2205
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
